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Key Clinical Message: In babies presenting with an omphalocele, other components of the prune belly syndrome should be scrutinized for early diagnosis and timely intervention. A male baby on his 13th day of life presented with an omphalocele. On evaluation, he had congenital absence of left kidney and bilateral cryptorchidism. Therefore, he was diagnosed with prune belly syndrome. He responded well to abdminoplasty, and wait and watch policy was applied for his cryptorchidism. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is a common surgical emergency amongst the paediatric population. Available diagnostic tools are focussed to make a diagnosis of acute appendicitis. A definitive predictive factor for the diagnosis of complicated appendicitis is lacking. Thus, this aims to analyse hyperbilirubinaemia as a predictor of complicated appendicitis amongst the paediatric population.Materials and Methods: A prospective observational study was conducted in a tertiary hospital from November 2018 to October 2019. All children undergoing emergency appendectomy were included in the study. Preoperatively, patients were evaluated clinically, and routine investigations including total and direct serum bilirubin were sent. All patients were grouped as 'simple appendicitis' or 'complicated appendicitis' based on intra-operative and histological findings. Bilirubin level was compared between these groups and analysed.Results: A total of 52 children fulfilling the inclusion criteria were included. The mean age was 13.2 ± 4.2 years, and the male: female ratio was 2.1:1. Thirty-four (65.4%) had simple appendicitis and 18 (34.6%) had complicated appendicitis. Total bilirubin was 23.83 ± 5.94 mmol/L in the complicated appendicitis group and 13.15 ± 3.29 mmol/L in the simple appendicitis group. Direct bilirubin was 5.28 ± 2.22 mmol/L in complicated appendicitis and 2.62 ± 0.83 mmol/L in simple one. Both total and direct bilirubin were significantly high in the complicated group (P < 0.001) compared to the simple appendicitis group. On the Receiver operating curve (ROC), the best cutoff value for total and direct bilirubin was 21 and 5.5 mmol/L, respectively. The sensitivity and specificity of total and direct bilirubin were 72.2%, 100%, and 61.1%, and 85.3%, respectively.Conclusion: It is concluded that hyperbilirubinaemia is a good predictor for paediatric complicated appendicitis. [ABSTRACT FROM AUTHOR]

Introduction Surgical correction is the only treatment for hypospadias. Complication rate is usually high. Indwelling catheter is kept postoperatively for urinary diversion and proper healing. There is no consensus regarding the duration of catheterization. This study was conducted to compare urethrocutaneous fistula (UCF) rate between one and three weeks of catheterization. Methods This study was a randomized control trial, conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. All children undergoing urethroplasty for hypospadias were randomized into two groups. After surgery, urinary catheter was kept for one and three weeks in group 1 and group 2 respectively. Occurrence of UCF and other complications were noted and compared between the groups. Results A total of 32 patients were randomized in to 2 groups having 16 in each group. Fourteen (43.8%) developed UCF. In one week group, 8 (50%) and in three week group 6(37.5%) developed UCF. It was not statistical different (p = 0.48). Occurrence of UCF was not different in different age of children, type of hypospadias and single or staged procedure. Meatal stenosis was not different in both groups. Conclusion Incidence of UCF was not different in one week or three week of urinary catheterization after surgery for hypospadias. [ABSTRACT FROM AUTHOR]

Introduction Alcohol is the most common abused substance in Nepal. Women tend to present with more severe liver disease with a shorter period of excessive drinking and at a lower daily alcohol intake compared to men. Methods Adult female patients aged 16 years and above, with a diagnosis of ALD were included for a period of 1 year. Liver disease secondary to other causes were excluded. Demographic profiles, clinical features, laboratory, endoscopic findings, Child-Turcotte-Pugh (CTP), Model for End-stage Liver Disease (MELD) of the patients were recorded. Results A total of 144 female patients with ALD were included in the study. The mean age of the patients was 48.6 years (SD=12.7). Majority of the patients were from Hilly region (n=66, 45.8%), married (n=135, 93.8%), housewife (n=83; 57.6%), Hindu by religion (n=93; 64.6%), and Tamang (n =39; 27.1%) by caste. Most common clinical features of the patients were abdominal distension (n=117; 81.2%), bilateral lower limb swelling (n=89; 61.8%), jaundice (n=54; 37.5 %) and anorexia (n=53; 36.8%). The main reason for alcohol consumption was found to be family custom in 42.3%. Esophageal varix was present in 119 (82.6%) patients. Out of 124 patients with cirrhosis, 63 (50.8%) patients were in CTP stage C and 103 (83.1%) patients had MELD score = 16. Conclusion ALD was predominantly seen among the younger female patients. The most common clinical presentations were abdominal distension, bilateral lower limb swelling, jaundice and anorexia. Among the cirrhotic patients, most of patients were in CTP class C and had MELD score = 16. [ABSTRACT FROM AUTHOR]

Foreign bodies with their long edges that penetrate the body are potentially life-threatening, owing to the resulting hemorrhagic shock and visceral damage. In an under-resourced environment, the outcome after major impalement injury can be improved by (a) rapid transport with the impaled object in situ (b) quick assessment and resuscitation in the emergency room (c) transport to operating room for definitive care. We report here the successful management of penetrating long iron rod injury from the perineum to the loin of pediatric patient, including transport from rural to tertiary hospital, diagnosis and, resuscitation. [ABSTRACT FROM AUTHOR]